AHW 5

First Health Network

AHW 5 is an indemnity-style health plan built on the First Health Network that pays set dollar amounts toward doctor visits, hospital stays, surgery, and prescriptions—with no deductible to meet first. It is best suited for generally healthy individuals who want predictable, low-cost coverage for routine care and want a safety net for unexpected medical events, and who do not have complex or ongoing medical conditions.

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Monthly premiums

member_only: $219.99/mo
child: $309.99/mo
spouse: $319.99/mo
family: $374.99/mo

The AHW 5 plan works differently from traditional insurance. Instead of requiring you to meet a deductible before benefits kick in, it pays a fixed benefit amount directly toward covered services. You can visit a primary care doctor up to 5 times per year for a $50 copay, and see a specialist or urgent care provider up to 5 times per year for a $75 copay. The plan taps into the First Health Network, which includes access to more than 993,000 professional providers, 5,700 hospitals, and 52,000 ancillary facilities nationwide, so finding an in-network provider is straightforward in most areas. Telemedicine is also included, giving you 24/7 access to board-certified physicians for primary care, urgent care, and mental health needs at no additional copay. For bigger medical events, the plan provides $1,500 per day toward inpatient hospitalization, up to a $15,000 annual maximum, plus $1,500 toward inpatient surgery and up to $4,500 toward outpatient surgery. If you visit the emergency room and are admitted, you receive a $1,000 benefit per incident, and ambulance transport when admitted is covered up to $500 per incident. Prescription coverage is included: preventive generic drugs are free, preferred generics cost $5, non-preferred generics run $5–$10, and brand-name drugs (with prior authorization) are $40—though there is a $150 monthly benefit limit per person for non-preventive drugs, and specialty medications are not covered. This plan is a good fit for individuals who are generally healthy, want affordable monthly premiums, and primarily need coverage for routine doctor visits and basic prescriptions. It is not a traditional comprehensive health plan, so it is important to understand its limits: doctor visit benefits are capped at 5 per year per category, hospital and surgery benefits are fixed dollar amounts (not full-cost coverage), and many services—including pregnancy, NICU care, radiation, chemotherapy, dialysis, durable medical equipment, skilled nursing, and specialty drugs—are not covered. There are a few important timing rules to keep in mind. All sickness benefits require a 30-day waiting period before they become payable. Pre-existing conditions are subject to a 12-month waiting period for hospitalization, surgery, and emergency room benefits—meaning those benefits won't apply to a pre-existing condition during your first year of coverage. The plan is guaranteed issue (no health questions required to enroll), but applicants should carefully review the full schedule of benefits and exclusions list to make sure this plan matches their expected healthcare needs.

Plan details

Primary Care Copay: $50
Specialist Copay: $75
Urgent Care Copay: $75

Benefits

Deductible
N/A – Indemnity plan
Copay
$50 / $75 / $75
PCP / Specialist / Urgent Care
Doctor Visits
PCP 5 per year/ Specialist 5 per year
Rx Coverage
$0 / $5 / $5–$10
Preventive / Preferred / Non-preferred · Brand: Not Covered
Hospitalization
$1,500/day · max $15,000/yr
12-mo pre-ex exclusion
Surgeries
$1,500 inpatient / $4,500 outpatient
12-mo pre-ex exclusion
ER
$1,000/incident
If admitted only · 12-mo pre-ex exclusion
Work Requirement
No work requirement
Guarantee Issue
Yes, 12 Month wait for pre- existing

AHW 5

Monthly premiums

Plan details

Benefits

Plan documents

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